‘Well, Grandma, I have some good and bad news for you.’

‘Oh?’ She said looking instantly stressed.

I waved the letter I was reading: ‘According to the doctor at the eye clinic, you’re 80 years old! Those vitamins I make you take must be working, they’ve rejuvenated you by 18 years!’ 

‘Well, what do you expect with that lot?’ She shrugged, unimpressed.

‘You have another appointment in 3 weeks. I’ll block the time out in my diary.’ I said, as I got up to go upstairs to ‘my office’.

Since I had started caring for her, I had to read all her mail as she had developed macular degeneration and has very poor eyesight. She has semi-regular appointments at the eye clinic but her condition isn’t going to improve. As I blocked the hour slot in my diary, I thought about how ridiculous it was for the eye clinic to send appointment letters to patients who can’t see. How would my grandmother have known what the letter was about if I wasn’t reading them to her?

3 weeks later, at 9 on a Friday morning, I helped my grandma sit down in the reception area to wait for her check up. It consisted of an eye test and an eye scan. I always insist on sitting in on the procedures so I can ask questions but rarely get any answers. On this particular appointment, she had to have eye drops to dilate her pupils for the scan, which meant she’d not be able to see for about 4 hours afterwards.

‘All done! You can go home now.’ Said the nurse after she’d done her scan.

‘Do her eyes look any different?’ I asked.

‘I don’t know, you’ll have to speak to the doctor.’ She answered. 

‘Ok, we haven’t actually seen a doctor yet. Do you think we can see one next time? I asked, politely. 

She shrugged and repeated that we could go home. 

‘Right. Come on grandma, let’s get you up.’ I said as I gently guided her up and out of the room. She was leaning heavily on me and really couldn’t see a thing. 

‘God! People will think I’ve been drinking.’ She said as I slowly got her out of the car. 

‘Nothing unusual there!’ I teased. 

‘OOOH! Naughty girl, it isn’t lunchtime yet.’ She replied. I guided her into the house, took her coat off, and took her to her armchair. 

‘Right, you’ll have to stay here for a bit.’ I said, taking her shoes off. ‘Do you need anything? Do you want some tea?’

‘Yes please. I really can’t see anything!’ 

‘It’ll get better soon.’ I reassured her.

As I was making tea, I thought about how she would have got home from the appointment had she been on her own, assuming she would have known about it in the first place. There is absolutely no consideration for after care in the NHS. Sending letters to patients who can’t see, and having no thought about how these patients might cope getting home after having seriously temporarily impaired their vision. The reliance on the (often-elderly) patients having someone to help them is implied, unfairly in my opinion. I wonder how many medical appointments are missed because patients can’t get to or from them.

This wasn’t the first time I’d been confronted by the shocking lack of after care.

Grandma had to have a cancerous growth on her face removed – having finally succeeded in getting a doctor to look at it after a full 2 years of trying. We got referred to a dermatologist who determined it had to be removed, they’d have to cut quite deep to make sure they’d removed all the cancerous tissue and we got a date booked in for a few months’ time.

After the procedure, the nurse instructed my grandma to put a steroid cream on the wound for 3 weeks and then apply vaseline twice daily for a few months to help it heal. Grandma, as is her habit, looked at me as if she was a shy child to confirm I’d understood the instructions. She regresses into being a toddler during any medical interaction and is unable (or, more likely, unwilling ) to take in an instructions. I nodded to the nurse as I took the cream tube she was handing to grandma.

‘I’ll have to do that as she can’t see where the wound is.’ There was a big gaping black hole right next to her eye where the growth had been removed. Good thing I’m not squeamish.

‘Oh right.’ Said the nurse.

‘How do patients who don’t have help do this ?’ I asked, not being able to resist.

She looked at me and shrugged, gently but firmly showing us the door. It wasn’t the nurse’s fault and I shouldn’t have said anything, I just couldn’t help my frustration from boiling over. How would someone who had no help in the same situation as my grandmother administer they own aftercare on a wound they couldn’t see or reach properly? Once a patient is out the door, it is not the NHS’s problem. More preventative and aftercare would mean less patients through the door in the first place.

The NHS is 75 years old this year, fittingly – it is like a lot of UK’s ageing population: on its knees, unable to get the help it needs, with unpaid carers bearing the brunt of it. I don’t know what the solution is but treating older people with respect and making the effort to get them the extra help they need has to be at the heart of it. This issue is only going to grow; with the Office for National Statistics projecting that the UK’s over 85 population will nearly double by 2040. Having a plan for elderly and less able patients should be a priority, we’re all only ageing in one direction and we’d all like to be treated with dignity and respect.